Recurrent Supraventricular Tachycardia Triggered by Tea Consumption in a Postoperative Adolescent Female: A Case Report

ABSTRACT

Supraventricular tachycardia (SVT) in adolescents may be triggered by physiological stress or caffeine. We report a 16‐year‐old girl who complained of palpitations, dyspnea, and regular tachycardia (170 beats/min) after tea intake. ECG showed SVT and intravenous adenosine restored sinus rhythm. Recognizing dietary stimulants as potential precipitants of SVT is important.

Key Clinical Message

Clinicians should maintain a high index of suspicion for dietary factors triggering arrhythmias. Every physician must be re‐emphasized about the importance a careful history‐taking, identification of triggers, and appropriate counseling regarding avoidance that can play a vital role in preventing recurrence and reduce morbidity.

1. Introduction

Among the significant tachyarrhythmia seen in adolescents and young adults, Supraventricular tachycardia (SVT) is the most commonly encountered in clinical practice [1]. Re‐entry mechanisms involving the atrioventricular (AV) node or accessory pathways, such as atrioventricular nodal re‐entry tachycardia (AVNRT) or atrioventricular re‐entry tachycardia (AVRT), are the common mechanisms of SVT [2]. Clinically, SVT presents with sudden onset of palpitations, dyspnea, chest discomfort, dizziness, or presyncope, and in some cases may result in hemodynamic compromise depending on ventricular rate and duration of arrhythmia.

Episodes of SVT are often paroxysmal. It may be triggered by physiological stressors such as fever, pain, dehydration, or emotional stress. Additionally, pharmacological and dietary stimulants are recognized to influence cardiac electrophysiology through adenosine receptor antagonism and catecholamine‐mediated sympathetic stimulation [3]. Energy drinks, chocolates, and even spicy food have been reported to trigger supraventricular tachycardia [4, 5, 6]. Caffeine has been studied extensively in relation to atrial arrhythmias. However, its role in triggering SVT in adolescents remains variably reported and not established consistently [7]. Moreover, there is limited literature documenting recurrent SVT episodes temporally associated with routine tea consumption.

We report a case of a 16‐year‐old female who developed SVT episodes following tea consumption in the immediate postoperative period after appendectomy. This case highlights the importance of recognizing dietary stimulants as potential triggers in susceptible individuals. It also underscores the need for careful dietary history in patients presenting with paroxysmal tachyarrhythmias.

2. Case History and Examination

A 16‐year‐old female presented to the emergency department with abdominal pain that was acute in onset and associated with nausea. Clinical evaluation and imaging confirmed the diagnosis of acute appendicitis. She underwent emergency appendectomy under standard perioperative management. Appendectomy was done under subarachnoid block with 0.5% bupivacaine (heavy). IV fluids, paracetamol, and ketorolac were used during perioperative period. Postoperatively, the patient was kept Nil per os (NPO). She remained clinically stable with normal vital parameters.

On the first postoperative day, oral intake was resumed, and the patient was given tea (approximately 180 mL) as part of dietary progression. Within 30 to 45 min, following ingestion, she developed sudden onset palpitations associated with shortness of breath. There was no chest pain or syncope. On examination during the episode, her pulse rate was 170 beats/min. Blood pressure was 100/70 mmHg, respiratory rate was 18 breaths/min, and oxygen saturation was 97% on room air. Cardiovascular examination revealed a regular tachycardia without murmurs. The patient remained conscious and oriented throughout the episode.

3. Differential Diagnosis, Investigations and Treatment

After history taking and clinical examination, the differential diagnosis of tachyarrhythmia was considered. A 12‐lead electrogram obtained during the episode demonstrated a regular narrow complex tachycardia with a ventricular rate of 170 beats/min and a QRS duration of < 0.12 s. P waves were not visible before the QRS complexes, and the findings were consistent with supraventricular tachycardia (Figure 1). Initial non‐pharmacological management with various vagal maneuvers, including Valsalva maneuvers, was attempted, but it failed to terminate the arrhythmia. Intravenous adenosine 6 mg was administered, resulting in the rapid conversion to normal sinus rhythm (Figure 2). The patient remained hemodynamically stable, with no hypotension, syncope, or signs of heart failure occurring during the episode.

FIGURE 1.

A 12‐lead electrocardiogram (ECG) demonstrating a regular narrow‐complex tachycardia with a ventricular rate of 170 beats/min and a QRS duration of < 0.12 s. P waves are not visible before the QRS complexes. The findings are consistent with supraventricular tachycardia (SVT).

FIGURE 2.

Electrocardiogram (ECG) demonstrating restoration of normal sinus rhythm following termination of supraventricular tachycardia (SVT).

Following stabilization, a detailed clinical history was obtained which revealed that the patient had experienced a few similar episodes of sudden onset of palpitations and breathlessness since the past year. Each episode used to occur shortly after tea consumption. The prior episodes had been self‐limiting and she did not seek any medical evaluation. There was no history of intake of energy drinks, caffeine tablets, decongestants, recreational drugs, or other stimulant substances. She did not have a history of fever, thyroid dysfunction, anemia, or chronic illness. Family history was negative for sudden cardiac death, arrhythmias, or structural heart disease.

Laboratory investigations, including complete blood count, serum electrolytes, and thyroid function tests, were within normal limits (Table 1). Transthoracic echocardiography demonstrated normal cardiac anatomy, normal valvular function, and preserved biventricular systolic function, with no evidence of structural heart disease.

TABLE 1.

Relevant investigations of patient.

Investigation	Reported value	Reference range
Hb	13.4 g/dL	12–15
Total leucocytes count	7.5 × 103/μL	4–11 × 103
Platelet count	290 × 103/μL	150–400 × 103
Blood urea	29 mg/dL	15–45
Serum creatinine	0.8 mg/dL	0.7–1.3
Serum Sodium	138 mg/dL	135–145
Serum potassium	4.4 mg/dL	3.5–5.5
Serum calcium	9.6 mg/dL	8.6–10
Serum Magnesium	1.8 mg/dL	1.6–2.6 mg/dL
2D echocardiography	Normal study

On the background of convincing history suggestive of temporal association between tea intake and onset of SVT, combined with exclusion of structural cardiac, metabolic, and endocrine causes, a diagnosis of probable tea‐triggered paroxysmal supraventricular tachycardia was made. The patient was managed with intravenous adenosine which led to termination of the SVT episode. For long‐term management, she was started on diltiazem sustained release 90 mg once daily, a calcium channel blocker, for prevention of recurrence. She was advised strict avoidance of tea and all caffeine‐containing beverages, including coffee, energy drinks, and chocolate‐based stimulants. Dietary counseling was provided to the patient and family regarding potential arrhythmia triggers.

4. Outcome and Follow‐Up

During hospital observation, no further episodes of tachycardia were noted after cessation of tea intake. Till six months of follow up, the patient remained asymptomatic and reported complete absence of episodes of palpitations or dyspnea. She demonstrated good adherence to medication and dietary modifications. Given the resolution of symptoms with conservative management and trigger avoidance, electrophysiological study was deferred at this stage. The patient was advised to remain on regular follow up and further evaluation will be planned only if the recurrence occurs despite adherence to dietary advice and medical therapy.

5. Discussion

SVT in adolescents is most commonly due to AVNRT or AVRT, which involve re‐entrant circuits within or near the atrioventricular node [2]. It is a narrow complex regular tachycardia identified in a 12‐lead ECG [8]. Many cases are idiopathic; however, identification of triggering factors is clinically important for prevention of recurrence. Tea, which was temporally associated with SVT occurrence in our case, also contains some amount of caffeine [9]. In addition, the role of other components of tea could be of interest for future research.

Caffeine, which is a naturally occurring methylxanthine, exerts significant effects on cardiac electrophysiology. Its primary mechanism involves antagonism of adenosine receptors, particularly A1 receptors in the atrioventricular node. Adenosine normally slows AV nodal conduction and suppresses re‐entrant tachycardias. By blocking this pathway, caffeine facilitates increased AV nodal conduction and predisposes susceptible individuals to tachyarrhythmias. Additionally, caffeine increases circulating myocardial excitability, all of which contribute to arrhythmogenesis [10, 11]. Adolescents may be particularly susceptible to stimulant‐induced cardiovascular effects due to lower body mass, increased autonomic responsiveness, and ongoing physiological development [12].

In our case, the postoperative physiological stress likely played an additional role. Surgical stress, pain, transient sympathetic activation, and possible mild dehydration are known to lower arrhythmia thresholds [13]. The introduction of tea during this vulnerable period may have acted as a precipitating trigger in a patient with underlying susceptibility.

Caffeine‐associated atrial arrhythmias and palpitations have been described in literature; however, reports of tea‐triggered SVT, particularly in postoperative pediatric patients, are rare [14]. Our case, therefore, adds to the limited evidence supporting dietary caffeine as a clinically relevant trigger of SVT in adolescents. This case also emphasizes the importance of obtaining a detailed dietary history in patients presenting with paroxysmal tachyarrhythmias. Recognition of reversible triggers is important, as it may prevent unnecessary use or escalation of pharmacological therapy. It also reduces the recurrence risk through minor lifestyle modification.

6. Limitation

The main limitation of our case report is that the recurrent episodes of SVT were only temporally associated with tea consumption. The exact amount of caffeine and other potentially contributory components in the tea could not be quantified. Post operative stress as well as concurrent medications may also have contributed to present arrhythmic episodes. Nevertheless, the history of occurrence of similar episodes shortly after tea consumption and the absence of recurrence following cessation of tea intake, together with medical therapy, suggest a temporal association. Further studies are needed to determine whether this association represents a causal relationship.

7. Conclusion

Although rarely reported, the episodes of supraventricular tachycardia in this adolescent were temporally associated with tea consumption. This temporal association highlights the importance of considering dietary stimulant intake when evaluating recurrent arrhythmias. Clinicians should consider caffeine‐containing beverages as a potential contributing factor and routinely inquire about dietary exposures when assessing recurrent SVT. A careful history, identification of potential triggers, and appropriate counseling regarding avoidance of suspected triggers may help reduce risk and associated morbidity.

Author Contributions

Mukti Nath Sankhi: conceptualization, writing – original draft, resources, investigation, data curation. Raj Kumar Thapa: conceptualization, validation, supervision, writing – review and editing. Pramila Dhakal: resources, writing – original draft, project administration. Nirmal Shrestha: writing – review and editing, resources. Nabin Adhikari: resources, writing – review and editing. Rajiv Sitaula: writing – review and editing, resources. Santosh Kumar Singh: conceptualization, supervision, validation.

Funding

The authors have nothing to report.

Ethics Statement

All procedures performed in this study involving human participants were in accordance with the institutional review committee.

Consent

Written informed consent was obtained from the patient's parent regarding publication of the data and images. Written informed assent was also obtained from the patient.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data used and/or analyzed during the current study are available from the corresponding author on reasonable request.